0 - National Criminal Justice Reference Service
0 - National Criminal Justice Reference Service
0 - National Criminal Justice Reference Service
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TEMPLE UNIVERSITY<br />
A Commonwealth University<br />
Center for Public Policy Gladfelter Hall, 10th Floor (025-02)<br />
12th St. and Berks Mall<br />
Philadelphia, Pennsylvania 19 122<br />
’ (21 5) 204-6696<br />
Fax: (2 15) 204-7779<br />
Subject Consent Form<br />
Participant’s Name:<br />
Project Title:<br />
(Please Print)<br />
Evaluation of Prison Based Drug Treatment in Pennsylvania: A Research Collaboration Between The<br />
Pennsylvania Department of Corrections and the Center for Public Policy At Temple University<br />
Investigators:<br />
Wayne N. Welsh, Ph.D.<br />
Associate Professor, Department of <strong>Criminal</strong> <strong>Justice</strong><br />
5th Floor, Gladfelter Hall (025-02)<br />
Temple University<br />
Philadelphia, PA 19 122<br />
Purpose<br />
The purpose of this research study is to evaluate the effectiveness of drug and alcohol education and<br />
treatment programs provided by the Pennsylvania Department of Corrections (DOC).<br />
Benefits<br />
I understand that I will be given the opportunity to request a summary of the study results. The<br />
information collected from this study will help DOC to assess the effectiveness of its current programs<br />
and improve the quality of drug and alcohol programming offered to inmates.<br />
General Research Procedures<br />
By giving my consent to participate, I understand that Temple researchers will have access to my DOC<br />
drug and alcohol treatment records and my DOC institutional records. To examine long term outcomes<br />
of treatment (e.g., drug relapse or recidivism), researchers will seek access to Department of Probation<br />
and Parole records and state criminal records for up to two years following my release from DOC<br />
custody. I understand that researchers may ask me to complete a survey and/or interview asking about<br />
my experience in this program. I understand that I may refuse to participate in a survey or interview at<br />
any time.<br />
ICONTINUE TO OTHER SIDE1<br />
Page 1 of 2<br />
This document is a research report submitted to the U.S. Department of <strong>Justice</strong>. This report has not<br />
been published by the Department. Opinions or points of view expressed are those of the author(s)<br />
and do not necessarily reflect the official position or policies of the U.S. Department of <strong>Justice</strong>.